ObjectiveTo compare acute treatment responses and long-term outcome in leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis.MethodsRetrospective case series of 118 patients with LGI1 antibody encephalitis evaluated at Mayo Clinic across all US sites from 1 May 2008 to 31 March 2019. Patient clinical data were identified and analysed through the neuroimmunology laboratory and electronic medical record. LGI1 antibody detection was by cell-based indirect immunofluorescence assay of serum, cerebrospinal fluid or both. Clinical outcomes were faciobrachial dystonic seizure (FBDS) resolution, modified Rankin Scale (mRS) score, Kokmen Short Test of Mental Status (STMS) score (0–38 point scale) and neuropsychometric testing results.ResultsCompared with intravenous immunoglobulin (IVIg) (n=21), patients treated with single-agent acute corticosteroids (intravenous, oral or both) (n=49) were more likely to experience resolution of FBDS (61% vs 7%, p=0.002) and improvements in mRS score (ΔmRS score 2 vs 0, p=0.008) and median Kokmen STMS scores (ΔKokmen STMS score 5 points vs 0 points, p=0.01). In 54 patients with long-term follow-up (≥2 years), the median mRS score was 1 (range 0–6) and the median Kokmen STMS score was 36 (range 24–38) after all combinations of immunotherapy. Neuropsychometric testing in 32 patients with long-term follow-up (≥2 years) demonstrated short-term memory impairments in 37%.ConclusionsCorticosteroids appeared more effective acutely than IVIg in improving LGI1 antibody encephalitis in this retrospective comparison of immunotherapies. While improvement with immunotherapy is typical and long-term outcome is favourable, short-term memory deficits are noted in approximately a third of the patients.

While up to 80% of medical errors may result from poor communication at clinical transitions of care, there has been relatively little study of the effect of standardized communication tools on clinical quality measures. We prospectively examined the effect of a standardized handoff checklist on clinical outcomes for patients dismissed from the neurointensive care unit. We found that the checklist resulted in significant reductions in patients transferred with inaccurate medication reconciliation and unnecessary urinary catheters. Participating physicians were surveyed and generally viewed the handoff checklist favorably. Standardized communication tools such as checklists may play a useful role in reducing medical errors related to communication between patient care teams.

Objective: To review descriptions of paroxysmal dysarthria and ataxia in multiple sclerosis (MS), with special attention given to Parker and his 1946 case series.Methods: Evaluation of original publications describing paroxysmal dysarthria and ataxia, bibliographic information, writings, and unpublished letters from the Mayo Clinic Historical Unit.Results: In 1940, Störring described a patient with MS with paroxysmal symptoms that included dizziness and trouble speaking, but also unilateral extremity weakness. In 1946, Parker published a series of 11 patients with paroxysmal dysarthria and ataxia. Six of these patients had MS, and he recognized this phenomenon as a manifestation of the disease. The term "paroxysmal dysarthria and ataxia" was first used in 1959 by Andermann and colleagues. Since that time, paroxysmal dysarthria and ataxia has become a well-recognized phenomenon in MS. More recent reports have suggested that the responsible lesion is located in the midbrain, near or involving the red nucleus. Paroxysmal motor and sensory phenomena are well-described complications of multiple sclerosis (MS). These stereotyped events are of sudden onset and brief duration, and can occur multiple times an hour. Paroxysmal symptoms that have been reported include diplopia, trigeminal neuralgia, facial paresthesia, pain, itching, tonic seizures, akinesia, and dysarthria and ataxia. [1][2][3] There is disagreement about who first described paroxysmal dysarthria and ataxia in MS, with some authors giving priority to Gustav Störring and others to Harry Lee Parker. Conclusions:2,4-7 Parker (figure) described patients with attacks of dysarthria and ataxia in 1946. Since then, paroxysmal dysarthria and ataxia has become a well-known phenomenon in MS, appearing in numerous neurology and MS textbooks. 1,2OBJECTIVE The objective of the study was to review the earliest descriptions of paroxysmal dysarthria and ataxia and its association with MS. Particular attention was given to Parker and his 1946 case series. The authors compared these early descriptions to subsequent case reports.METHODS The authors evaluated original publications describing paroxysmal dysarthria and ataxia in patients with MS, as well as bibliographic information, writings, and unpublished letters from the Mayo Clinic Historical Unit pertaining to Harry Lee Parker. The Harry Lee Parker Collection in the Mayo Clinic Historical Unit contains a quarter foot of material. PubMed was searched using the search term "paroxysmal dysarthria and ataxia" to identify more recent case reports and case series.

Objective: To compare the yield of epileptiform abnormalities on 30-minute recordings with those greater than 45 minutes.Methods: We performed a prospective observational cross-sectional study of all outpatient routine EEGs comparing the rate of interictal epileptiform discharges (IEDs) and clinical events during the initial 30 minutes (routine) with those occurring in the remaining 30-60 minutes (extended). A relative increase of 10% was considered clinically significant.Results: EEGs from 1,803 patients were included; overall EEG duration was 59.4 minutes (SD 66.5). Of 426 patients with IEDs at any time during the EEG, 81 (19.1%, 95% confidence interval 15.6-23) occurred only after the initial 30 minutes. The rate of late IEDs was not associated with age, indication, IED type, or sleep deprivation. Longer recording times also increased event capture rate by approximately 30%. Conclusions:The yield of IED and event detection is increased in extended outpatient EEGs compared to 30-minute studies. Neurology ® 2016;86:1524-1530 GLOSSARY AED 5 antiepileptic drug; CI 5 confidence interval; CMS 5 Centers for Medicare and Medicaid Services; DI-EEG 5 temazepam EEG protocol; IED 5 interictal epileptiform discharge; NES 5 nonepileptic spell; r-EEG 5 routine EEG protocol; SD-EEG 5 sleep-deprived EEG protocol.